Put the Junction City hospital to better use

GUEST VIEWPOINT: Put the Junction City hospital to better use
By Gary Crum, published in The Register-Guard, April 10, 2017

In a March 9 guest viewpoint, state Rep. Julie Fahey, D-Eugene, argues that we must keep the Junction City hospital open. As one of the most outspoken opponents of the construction of the hospital and a continued critic of its operation, I say we must close the Junction City hospital.
Fahey cites the mission of the state mental health system: “therapeutic, evidence-­based, patient-centered treatment focusing on recovery and community reintegration.” She does not mention that a key mandate for mental health treatment requires that it be provided in “the least restrictive treatment setting available.” The Junction City state hospital, a high-security, locked-ward facility, is the most restrictive treatment setting available.

I, along with every professional psychiatric group in the state and every patients’ advocacy group, favored the state investing in earlier intervention with 16-bed community-based facilities, walk-in clinics, short term intervention and diagnosis facilities, out-patient support systems, and mobile intervention crisis teams such as CAHOOTS. The Legislature, instead, chose to spend more than $100 million to build the Junction City hospital with an annual cost of over $400,000 per patient At full capacity, that per-patient cost would drop to $280,000 per year.

At the time Gov. Kate Brown proposed the closure of the Junction City hospital, there were enough open beds at the Salem hospital to serve all the patients from Junction City. The statement that the closure would result in overcrowding, an unsafe environment for employees and a reduction in patients’ overall quality of care is a scare tactic. Additionally, if we keep that “least restrictive treatment setting available” in mind, it’s quite likely that some (perhaps many) of the patients now in locked-ward facilities could be safely, more humanely and more effectively served in community-based facilities.

The Catch-22 is that construction and staffing of the Junction City hospital has monopolized available funding, leaving a void where those less restrictive treatment settings should be on the continuum of services. Those community-based 16 bed facilities cost about $70,000 per patient per year. Additionally, the federal government has been reimbursing states about 50 percent of the cost of such services.

Locked-ward placement does not qualify for such reimbursement. This means that, even at that full-capacity cost of $280,000 per patient per year at the Junction City hospital, the state could provide for eight patients’ placement and treatment in a community-based facility for each locked-ward patient. At the hospital’s current cost of $400,000 per patient, it’s more than an 11-to-1 ratio. The state has put all its mental health care dollars in one basket — the wrong basket.

The $100 million to build the Junction City hospital has been spent. That’s the strongest argument for continuing to fund it. There’s no doubt in my mind that, given current patient populations, fiscal realities and the need for community-­based services, that hospital would not be built today. But it has been built, so what does the state do with the facility if it’s closed?

We know that many of those incarcerated in our prisons today are young, have drug or alcohol abuse issues that were associated with their crimes, and do not do well in the general prison population. We’ve heard repeatedly that such people need treatment, not prison. I agree. The Junction City hospital facility is built to the security level of a minimum- or medium-­security prison.

I suggest the hospital be converted to a minimum- or medium-security state corrections facility dedicated for the incarceration and treatment placement of people identified by the courts as appropriate candidates for such placement. I suggest the rehabilitation programs at the facility be specifically focused on substance and alcohol abuse treatment, job skills and personal development to promote employment and successful reintegration into the community upon release. This could be a model program, truly focused on rehabilitation and reintegration.

The governor’s proposed budget includes $20 million to reopen a mothballed women’s prison near the Oregon State Penitentiary. An easy, cost-effective move would be to, instead, move the current Junction City hospital patients to the Salem hospital (there is room) and transfer ownership of the Junction City facility to the Department of Corrections to meet that need for expanded capacity. This would release millions of mental health dollars for community support, save the Department of Corrections the cost of refitting and reopening a shuttered facility, provide a state-of-the-art facility for the women’s prison, and keep the employment base provided by the Junction City facility.

We have built the hospital. It’s not necessary for its current use. We have a need which can be met by putting it to another use, promoting community mental health care, saving the state tens of millions of dollars, and protecting local jobs. Let’s consider an opportunity that would benefit all of us.

Gary Crum of Junction City is a retired teacher and counselor.